Meeting mental health targets will be a challenge, says NAO

A National Audit Office report has concluded that the Department of Health and NHS England are starting to make headway on actions necessary to instil new access and waiting times standards for people with mental health conditions, but also stresses that “much needs to be done”.

In October 2014, the DH and NHS England unveiled a first set of standards for the access to mental health services that people should expect and how long they should have to wait for treatment. However, the full cost of their implementation and of meeting other longer term ambitions for service improvement is not well understood, the NAO says.

The government has estimated that achieving initial commitments - improving access to psychological therapies, early intervention in psychosis and liaison psychiatry services - could be £160 million a year more than the £663 million that clinical commissioning groups are thought to have spent on them in 2014/15.

According to the report, subsequent analysis suggests that the cost of improving access further could be substantially higher, although there is “considerable uncertainty” around these estimates, and while NHS bosses have made available £120 million of additional funding over the last two years, “most of the cost of implementing the standards will be met from CCG’s existing budgets, at a time when the NHS is under increasing financial pressure”.

Full data does not exist to measure how far the NHS is from meeting the access and waiting time standards, “but it is clear that meeting the standards will be a very significant challenge,” the report warns. Access and waiting times for improving access to psychological therapies are already being met nationally but performance varies substantially, while a survey of acute hospitals last year indicated that 7% had the level of service NHS England considers will be beneficial to patients.

The Department and NHS England are making progress, “particularly in setting priorities and national leadership, but significant risks to implementing the access and waiting times programme remain”, the NAO warns, concluding that the the strongest areas are the clear objectives and strong leadership, but the greatest challenges for the future are collecting data to show whether the standards are being met, building the mental health workforce and reinforcing incentives for providers.

“The Department of Health has recognised that mental health has been treated as a poor relation relative to other health needs for many years. This recognition, the goal of ‘parity of esteem’ and the setting of new standards for access and waiting times are all bold and impressive steps forward,” noted NAO head Amyas Morse, but also stressed that “it is important that these steps are supported by implementation in a reasonable timescale if they are not to be a cause for disillusionment, and this looks challenging in current conditions”.

“We must urgently move on from describing the problem to actually making a difference. Behind the headlines lies widespread problems in access to mental health services, affecting some of the most vulnerable people in our society including children.”

“It's time national leaders stopped making promises that things will improve and focused on getting resources to the frontline,” he said, adding: “It is a scandal that there is no accountable and transparent system for understanding where the Government’s promised funding for mental health services has gone.”

Earlier this year, the DH promised to invest NHS England is to invest an extra £1 billion a year into improving mental health services, in line with a wide-reaching package of recommendations made by the Mental Health Taskforce.